High Fibrosis-4 is Associated With Increased Risk of Cirrhosis Decompensation and Liver-Related Mortality in at-Risk Patients With Metabolic Dysfunction–Associated Steatotic Liver Disease

Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent and a proportion of affected individuals (<5%–10%) progress to advanced fibrosis, with a risk of developing complications of cirrhosis over 10–20 years.1 Identifying individuals at risk of future liver-related events and mortality is crucial to enable treatment to slow liver disease progression, and to refer people with advanced fibrosis for hepatology care. Clinical guidelines recommend use of the Fibrosis-4 (FIB4) score as the initial test to identify people with MASLD at low risk of advanced fibrosis (FIB4 <1.30) who can be managed in primary care.